Surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC). However, most of patients lose the chance of surgery due to the unresectable disease at the time of diagnosis. Despite the improvement of radiological imaging, a portion of patients intended for radical resection were proven to be unresectable at surgical exploration due to occult metastasis.
Patients who were aimed to undergo radical pancreatectomy for PDAC from 2010 to 2019 were reviewed retrospectively. All patients included underwent diagnostic laparoscopic exploration. Patients were divided into two groups depending on whether distant metastasis were encountered during exploration. Univariate and multivariate logistic regression analyses were used to identify risk factors for occult metastasis. A nomogram to predict occult metastasis of PDAC on exploration was developed and evaluated.
A total of 273 patients who underwent diagnostic laparoscopic exploration were included in this study. Nineteen (7.0%) patients were found with distant metastasis during exploration. Multivariate logistic regression analysis showed that ALT&gt;40U/L, CA19-9, CA125 and regional nodes enlargement were independent predictors for occult metastasis. Incorporating these four factors, the nomogram achieved concordance index of 0.799, with a well-fitted calibration curve.
Occult metastasis is not unusual during surgical exploration in patients with resectable or borderline resectable PDAC. The nomogram could achieve a personal prediction of unexpected distant metastasis on exploration. It may help to sift through patients with PDAC who would benefit from laparoscopic exploration.
Occult metastasis is not unusual during surgical exploration in patients with resectable or borderline resectable PDAC. https://www.selleckchem.com/products/fx11.html The nomogram could achieve a personal prediction of unexpected distant metastasis on exploration. It may help to sift through patients with PDAC who would benefit from laparoscopic exploration.Although the origin of the multifocality of papillary thyroid carcinoma (PTC) is unclear, it is not unusual and has not been considered as an independent prognostic factor from several tumor staging systems. This study aims to evaluate whether the presence of multifocality is associated with PTC recurrence.
We reviewed retrospectively detailed histological reports of PTC patients who underwent thyroidectomy from January 2000 through December 2010 at a single institution. We assessed the relationship between multifocality and other possible prognostic factors using binary logistic regression analysis. We compared recurrence by the Kaplan-Meier method (the log-rank test). We analyzed a prognostic factor for recurrence using Cox's proportional hazard model (the stepwise forward method).
We enrolled a total of 434 PTC patients (380 women and 54 men; mean age, 48 years). The median follow-up period was 10.2 years. Of all PTC patients enrolled, 135 patients (31%) had multifocal PTC. There was a significant association between multifocality and cervical lymph node (CLN) metastasis (P=0.01). Multivariate analyses showed a significant association between multifocality and CLN metastasis (P&lt;0.001). Multifocal PTC patients had higher CLN metastasis and tumor recurrence than those with single PTC. There was a significant association between multifocality and tumor recurrence (P=0.03 by log-rank test), but it disappeared in multivariate analysis.
Multifocality of PTC might be related to CLN metastasis and tumor recurrence.
Multifocality of PTC might be related to CLN metastasis and tumor recurrence.To determine the histopathological and MRI features of BRCA1/2 mutation-associated familial breast cancers compared with those of BRCA1/2 mutation-negative and sporadic breast cancers and to further compare the imaging features of cancers from BRCA1 and BRCA2 mutation carriers according to lesion type on MRI.
A retrospective review of medical records was conducted to determine tumour clinicopathologic features and MRI characteristics between June 2011 and July 2017, and 93 lesions with BRCA mutations, 93 lesions without BRCA mutations from familial breast cancers and 93 lesions from sporadic breast cancers were included. Histopathologic data, including immunohistochemistry findings and MRI data according to the BI-RADS lexicon, were reviewed. The association between MRI or histopathologic findings and BRCA mutations was analysed.
BRCA-positive familial breast cancers had a higher number of IDCs with high nuclear grade and lymph node metastasis (all P&lt;0.05), while the BRCA-negative group had a signifiifferences in their clinicopathologic features.Our study aimed to compare the efficacy and safety of anthracycline plus taxane (AT)-based neoadjuvant chemotherapy (NAC) with or without cyclophosphamide in the treatment of breast cancer.
We searched PubMed, Embase, Web of Science and the Cochrane Library for randomized controlled studies comparing the efficacy and safety of AT-based NAC with or without cyclophosphamide in breast cancer patients.
Four eligible studies with 2,302 individuals were ultimately included in the quantitative analysis. After applying the AT-based NAC regimen, the overall rates of pathologic complete response (pCR) and breast conserving surgery in all included subjects were 26.5% and 70.6%, respectively. The rates of pCR [risk ratio (RR) 1.35; 95% CI 0.75, 2.45; P=0.32], breast-conserving surgery (RR 1.07; 95% CI 0.97, 1.19; P=0.17) and clinical response (RR 1.08; 95% CI 0.97, 1.19; P=0.15) in patients in the cyclophosphamide group were similar to those in the control group. However, participants in the cyclophosphamide group had a lower no clinical response rate than those in the control group (RR 0.72; 95% CI 0.60, 0.87; P&lt;0.001). Subjects in the cyclophosphamide group had significantly lower rates of infection (RR 0.57; 95% CI 0.41, 0.79; P&lt;0.001) and diarrhea (RR 0.46; 95% CI 0.30, 0.68; P&lt;0.001) and higher rates of thrombocytopenia (RR 3.38; 95% CI 1.96, 5.84; P&lt;0.001), sensory/motor neuropathy (RR 1.57; 95% CI 1.03, 2.39; P=0.03) and nausea/vomiting (RR 1.51; 95% CI 1.11, 2.06; P=0.009) than those in the control group.
The AT-based NAC regimen with or without cyclophosphamide had similar clinical outcomes in breast cancer patients. The addition of cyclophosphamide might increase the risks of thrombocytopenia, sensory/motor neuropathy and nausea/vomiting.
The AT-based NAC regimen with or without cyclophosphamide had similar clinical outcomes in breast cancer patients. The addition of cyclophosphamide might increase the risks of thrombocytopenia, sensory/motor neuropathy and nausea/vomiting.